Medicare Physicians

News & Analysis as of

Legal Issues Associated with Multi-Provider Alternative Payment Model

Since the passage of the Affordable Care Act (ACA), both federal and state policies have promoted the adoption of alternative payment models (APMs), providing financial incentives for groups of providers to improve care...more

CMS Unveils Revised Voluntary Self-Referral Disclosure Protocol

On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to its Voluntary Self-Referral Disclosure Protocol (SRDP), through which providers may disclose actual or potential violations...more

CMS Proposes Extension of Medicare Self-Referral Disclosure Protocol Lookback Period to Six Years

CMS has published a notice inviting comments on a revised Medicare Self-Referral Disclosure Protocol (SRDP), which is a vehicle for providers and suppliers to voluntarily self-disclose actual or potential violations of the...more

The Future of Medicare Physician Reimbursement: 10 Major Takeaways from the MACRA Proposed Rule

On April 27, 2016, just over a year after the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, the Department of Health and Human Services (HHS) unveiled the long-awaited proposed rule to begin its...more

CMS Proposes “Advancing Care Information” Program to Replace Meaningful Use

The Medicare Access and CHIP Reauthorization Act (MACRA) proposes a new approach, with new branding labels, to paying clinicians for the value and the quality of care that they provide by replacing a patchwork of existing...more

2016 Stark Law Updates

Centers for Medicare and Medicaid Services (CMS) issued the 2016 Medicare Fee Schedule (the "Schedule") in an effort to facilitate compliance with the Physician Self-Referral Law (the "Stark Law"). Generally, absent an...more

CMS Issues MACRA Proposed Rule on Quality Payment Program for Physicians and Other Clinicians

On April 27, 2016, CMS issued a Proposed Rule that would implement certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) to modify the payment system for physicians and other clinicians. ...more

CMS Releases Proposed Rule for MACRA Implementation – Overview and Merit-Based Incentive Payment Systems (MIPS)

On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would put in place key parts of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA impacts a number of...more

CMS Publishes Proposed Rule Implementing MACRA Physician Payment Model

On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) posted a pre-publication version of a proposed rule implementing changes to Medicare payment for physician services authorized under the bipartisan...more

Court Dismisses Major False Claims Act Case Against Hospice Provider: Ruling Mere Difference of Medical Opinion is Insufficient...

On March 31, 2016, the United States District Court for the Northern District of Alabama in U.S. ex rel. Paradies v. AseraCare, Inc. dismissed a major False Claims Act case against a national hospice provider after ruling...more

CMS Announces Major Multi-Payer Comprehensive Primary Care Plus (CPC+) Model

CMS has launched a new “Comprehensive Primary Care Plus” (CPC+) model to improve how primary care is delivered and reimbursed. According to CMS, the CPC+ initiative (which builds on the ongoing Comprehensive Primary Care...more

OIG Examines Hospice Medicare Billing for General Inpatient Care

According to a recent OIG report, hospices billed inappropriately almost one-third of Medicare general inpatient care (GIP) stays in 2012, resulting in $268 million in inappropriate Medicare payments. The GIP level of care...more

Health Care/Health Care Litigation Advisory: Update on the AseraCare False Claims Act Litigation – A Win for AseraCare and Health...

In November 2015, we published a client advisory on the closely watched AseraCare litigation and its potential impact on the falsity element under the False Claims Act (FCA). AseraCare involves allegations that a hospice...more

District Court Deals Blow to DOJ in False Claims Act Case

Last week, the United States District Court for the Northern District of Alabama handed the Department of Justice (DOJ) a significant defeat by dismissing a False Claims Act (FCA) case against AseraCare, a national hospice...more

Judge Sides with AseraCare, Grants Summary Judgment in $200 Million FCA Case

Much like the rest of the health care world, we have been following the AseraCare case since May of last year when the Alabama federal district court granted AseraCare’s motion to bifurcate its False Claims Act (FCA) trial...more

False Claims Act Trial Sets Precedent for Future Cases

The DOJ’s theory of falsity based on clinical disagreement alone fails as a matter of law. In a closely watched False Claims Act (FCA) proceeding by the healthcare industry and FCA practitioners, the US District Court...more

CMS Moving Ahead on Medicare Physician Payment Reform; Proposed MACRA Rule at OMB

The White House Office of Management and Budget (OMB) is now reviewing a highly-anticipated Centers for Medicare & Medicaid Services’ (CMS) proposed rule to implement major Medicare physician payment reform provisions...more

CMS Delays Enforcement of Medicare Part D Prescriber Enrollment Requirement Until February 1, 2017

CMS is delaying until February 1, 2017 enforcement of previously-adopted regulations that require physicians and other eligible professionals who prescribe Part D drugs to be enrolled in Medicare (or have a valid opt-out...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 15, 2016, the Centers for Disease Control and Prevention (CDC) issued voluntary guidelines entitled, “CDC Guidelines for Prescribing Opioids for Chronic Pain — United...more

The "predicate facts" rule: Providers, be vigilant!

Medicare GME payments do not compensate teaching hospitals for their actual costs of training residents in a given year. Rather, Medicare GME reimbursement is determined, in part, on the basis of historic cost data and...more

CMS, AHIP Release Multi-Payer Physician Quality Measure Sets

CMS and America’s Health Insurance Plans (AHIP) recently released seven sets of physician clinical quality measures as part of a “Core Quality Measures Collaborative” intended to align quality measures among payers and reduce...more

CMS Signals that Meaningful Use Program Will Change Significantly for Physicians

On January 11, 2016, CMS Administrator Andy Slavitt announced that the Medicare Electronic Health Record Incentive Program will be replaced significantly in 2017 by the new Merit-Based Incentive Payment System (MIPS) for...more

GAO Recommends Equalizing Payment for Evaluation & Management Visits

The Government Accountability Office (GAO) has issued a report examining trends in “vertical consolidation” — hospital acquisition of physician practices or hiring of physicians as salaried employees – and the impact on...more

GAO Recommends Payment Reform in Response to Increase in Hospital/Physician Consolidation

On December 18, 2015, the Government Accountability Office (GAO) released a report analyzing the increase in hospital/physician consolidation and a related increase in Medicare hospital outpatient spending. Finding that...more

CMS Schedules Call on MACRA Global Surgery Data Requirement (Jan. 20)

On January 20, 2016, CMS is holding a call on data collection requirements related to global surgical periods as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Under this provision, the...more

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